急性前壁ST段抬高型心肌梗死后冠状动脉微循环障碍对患者远期心功能及预后的影响

Impact of Coronary Microcirculation Dysfunction on Long-term Cardiac Function and Prognosis in Patients With Anterior Wall Acute ST-segment Elevation Myocardial Infarction

目的:评估急性前壁ST段抬高型心肌梗死(STEMI)后冠状动脉微循环障碍(CMD)的情况,并探讨其对患者远期心功能及预后的影响。方法:回顾性入选2016年8月至2021年9月北京大学人民医院因前壁STEMI住院并于住院期间完成心肌声学造影(MCE)的患者73例。根据MCE结果分为CMD组(n=54)及对照组(n=19)。对患者进行随访,比较两组患者随访期间超声心动图资料及初步观察主要不良心血管事件(MACE)发生情况。结果:73例前壁STEMI患者中MCE证实存在CMD者54例(74.0%),与对照组相比,CMD组患者心肌肌钙蛋白I(cTnI)峰值水平更高[80.0(30.0,124.0)ng/ml vs.22.4(1.4,67.2)ng/ml,P=0.002]。对患者中位超声心动图随访3.6(2.5,6.0)个月,总回访率67.1%,校正cTnI峰值后,随访时CMD组患者左心室射血分数(LVEF)显著低于对照组[(50.1±11.8)%vs.(61.3±8.0)%,P<0.001],LVEF<50%的比例显著高于对照组(48.6%vs.8.3%,P=0.013),中位随访10.9(5.7,22.4)个月,对照组和CMD组的总MACE发生率差异无统计学意义。结论:前壁STEMI后发生CMD可影响患者远期心功能,亟待加强关注及管理。

Objectives:To evaluate the incidence of coronary microcirculation dysfunction(CMD)in patients with anterior wall acute ST-segment elevation myocardial infarction(STEMI)and explore its impact on long-term cardiac function and prognosis.Methods:We enrolled 73 patients with anterior wall STEMI who had undergone myocardial contrast echocardiography(MCE)during hospitalization from August 2016 to September 2021.Patients were classified into CMD group and non-CMD group according to the MCE results.Patients were followed up and the echocardiography(ECHO)data and major adverse cardiovascular events(MACE)were compared between the two groups.Results:CMD was evidenced in 54 patients(74.0%).The peak cardiac troponin I level(cTnI)of CMD patients was significantly higher than that of the non-CMD group(80.0[30.0,124.0]ng/ml vs.22.4[1.4,67.2]ng/ml,P=0.002).Patients were followed-up with the total follow-up rate of 67.1%.The median ECHO follow-up time was 3.6(2.5,6.0)months.After adjusting peak cTnI level,the LVEF of CMD patients was significantly lower than that of the non-CMD group during follow-up([50.1±11.8]%vs.[61.3±8.0]%,P<0.001).The ratio of LVEF<50%was significantly higher in CMD group than in non-CMD group(48.6%vs.8.3%,P=0.013).During 10.9(5.9,22.4)months follow-up,there was no significant statistical difference of total MACE incidence between non-CMD and CMD groups.Conclusions:CMD is associated with worse long-term cardiac function in patient with anterior STEMI and thus requires more attention and appropriate management during the disease process.